Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Wednesday, March 19, 2008

I disguised the title to please the HIPAA Nazi lady. Sorry I've been gone for a while. We were on Spring Break and had no internet access in the mountains of Arkansas.

I came back to town to see a great guy. Mr. Denny Abernathy from 3488 Wilder Road in Missoula, Montana (Social Number 654-90-7743) came to my ER on my first day back from vacation. His complaint was: "yesterday, I was pissin' blood and blood clots".

"Were you having any pain?" I asked. "Naw" he responded.

I asked "How much blood did you have in your urine?" He paused a moment, then reached into his bag and dug out a digital camera. He began to review the photos and proceeded to show me 6 pics of a toilet with dark bloody water and blood clots along the bowl. He had several angles covered. It was very artistic.

"Wow" I exclaimed, "You've got enough photos to start a scrapbook!". He looked thoughtful at this statement. "Have you had any blood in your urine today?" I asked.

"No, it was yaller this mornin'" he informed me.

"Did you get any photos of that for me?" I asked. "No, I'm sorry, I didn't think about it" he replied.

He added helpfully: "I thought I might have one of them kidney stones, and I heard that you're s'posed to strain your piss if that happens. But I didn't know what to use. So I went to the kitchen and found my tea strainer...you want it?"

Before I could even process what he'd said, he reached into his bag and withdrew a tea strainer filled with blood clots wrapped in Saran Wrap!

I looked through the strainer and just found a bunch of clots. Surprisingly, he didn't want it back when I was done. (He said that he'd take his American Express 6576-842099-54311 exp 7/09 and buy a new one).

After a work-up, he had a 12 mm stone completely obstructing his kidney. He got admitted for a stent and a stone removal!

Welcome back from vacation! It's so nice to have the HIPPA bitch on a MDOD stakeout. I hope she chokes on a donut.

43 comments:

~~~ waves to HIPPA Biatch ~~~ Welcome back Doc... been lurking in the shadows for a few days.. wanted to say hello. Great post! I used to be a billing manager for a mental health clinic so *you know who* already knows who I am! I'm now a county dispatcher for a 911 COMM center. I have found alot of useful info here (wit,humor,sarcasm,etc.) and plan to check in on you wonderful people regularly!

Nevermind that HIPAA was passed in order to protect patient records from docs who had them on their PDA's, or had web sites that patients could visit to see their labs.

Because of their wonderful law, I have trouble getting records on patients that I'm taking care of from other hospitals. Pharmacists don't want to discuss patient's meds over the phone, and I never get follow up on kids that get transferred to the Pedi referral hospital anymore. All because of HIPAA and people like this bitch over-interpreting the law and the intent of the law.

Just like every freakin' bureaucrat, this is that lady's ticket to fame. She's proving her worth by creating a job for herself, hell she even got herself a sign with her name on it at those hearings! Speaking as one who ACTUALLY DOES the work instead of regulating and talking about it....go to hell.

Nevermind that we have taken great pains to protect patient privacy and confidentiality on this site. That isn't a good news story, so they distort our site and what we say.

Now all of you non-medical folks see the kind of crap we bitch about on the site. The high heeled, clipboard carrying nurses who couldn't start an IV if their life depended on it making policy, discussing medicine as "an expert".

An "expert" is someone who can actually DO the job. Not someone with peripheral knowledge about it.

Glad to have you back from God's country (Arkansas). Body fluids are great. Around my house my little boy has been digging through his poo to find a lego he swallowed. We told him he would die if he put them in his mouth, and when he woke this morning he said "I'm glad I'm not dead". Me too.

I had a similar experience recently, a patient complained of funny colored stools (He said "Turds"). When I asked him to describe the color, he pulled out an album of Turd pics, and they indeed were a funny color, a violet with just a hint of blue. Although his bigger problem is taking pics of his turds, I pondered the diagnostic puzzle.

Those HIPAA forms drive me bananas. I have about 100 different doctors, and every time I see one after the first of the year or whatever asinine timetable they decide they need a new one filled out I have to list each doctor and say it is ok for them to share my info. I don't give a crap who sees my medical info anymore, and I think there should be a way to just write that. HIPAA forms can suck it.

Sorry...I appear to have had too much coffee today. I spent the morning at my daughter's honor roll assembly and needed it to stay awake through it all. I am proud of her and all, but 3 grades full of students having their names called one by one is just way too much!

anon: yeah, sometimes the pictures help. But in this case, I didn't have any reason to doubt the patient's story. The photos were just disgusting and funny.

Sometimes, I wish people could prove to me the crazy shit they claim.

Yesterday, I had a mother INSIST that her 7 year old kid vomited a Breakfast Jack...and they hadn't eaten there in over 2 weeks!

There are the women who have had "severe" vaginal bleeding for 6 months soaking 20 pads a day (and they have normal vital signs and a normal hemoglobin).

There are the folks who insist that they've vomited "everything" they have tried to eat and drink for 2 weeks..and they aren't tachycardic and have a normal potassium, normal BUN, and normal creatinine.

Or the ones with a 0.5 cm laceration to the finger who are worried because they "almost bled out" and their floor at home is "covered with blood". I'd love to wade them through the trauma room after a trauma thoracotomy on a hemophiliac! "Now THIS is bleeding out", I'd say.

Few years ago, I had a skaterboy come in with a laceration to his arm. He showed me the video of how it happened. It was pretty cool (and it was amazing that he didn't break his neck too). He filmed the laceration repair as well and couldn't wait to show the video to his friends.

erdoc85-I laughed about the severe vaginal bleeding...would you have wanted proof as in her bringing in the pads????

BTW that is why I had to have my hysterectomy. My level kept going lower and lower despite all the different medicines and stuff they tried to stop the bleeding. Towards the end I couldn't even walk around my house without bleeding through everything and feeling like I was going to die/pass out or something. I resorted to crawling around at one point and when I had my blood test, it was indeed too low so I guess I wouldn't have needed to save the pads (gross!)(now do you all still think I am hot? Why would I tell you such gross stuff? Someone needs to remind me not to drink so much coffe and then comment on blogs!)

Actually, for what it's worth, I think mice, along with all mammals can carry rabies; as far as I know there are no documented cases of mouse to human transmission. I think cases of rabid mice are rare because the mice usually don't survive the bite of the predator.

What's so weird about bringing in the bat that bit her? Couldn't the bat be sent to the lab that examines animals for rabies to see if she needed the shots or not? Maybe they don't do that anymore, but when I was a kid, the shots were horrid, and you wanted to avoid them if at all possible.

welcome dr peel! contrary to my prior guess you are really perceptive. i am young, and hot! in retrospect, bringing a live bat into the hospital was a really good idea. the shots aren't so bad anymore by the way. cheers and come by anytime!

"There are the folks who insist that they've vomited "everything" they have tried to eat and drink for 2 weeks..and they aren't tachycardic and have a normal potassium, normal BUN, and normal creatinine."--Maybe not EVERYTHING, but you can vomit a whole damn lot, over a long period, and have normal vitals and lab values. I had an eating disorder for years and at times I was puking 3 or 4 times a day, but aside from bradycardia most of the time (and runs of SVT every so often) everything checked out. Then again, I think you're talking about the fine examples of humanity who show up at triage bitching about nausea, clutching a McDonald's bag in a greasy paw. I agree: no Phenergan or Compazine for you.

And re: rabies from bats...did you know you can get it from aerosolized bat guano (happened to 2 spelunkers in Texas during the '50s)? Freaking bizarre.

They say that confession is good for the soul. I never got that. But confession may be good for relationships.

I'm not WCR. I just thought his idea of calling all of his patients "Deborah Peel" was hilariously funny. So I took a page out of his book (or post off of his blog), and decided to sort of pose as him posing as her. I want to be anonymous, too, and what better way than using a medical pseudonym on medical blogs?

I apologize to anyone who may have been embarrassed or offended by my little stunt, especially to White Coat Rants. WCR, may your tribe increase.

Oh, and 911DOC, I do think you are hot. I'm sure Deborah Peel would agree with that.

oooh...I hope she does too!I love this site! You are an irreverent salvation to the world of medicine, a world I have worked in and dated/almost married for almost 20 years. My current fiance is a physician as well, and we are in awe of how shitty the healthcare system is in this country. Every day we are closer to planning our escape.

steph, we feel your pain. i would disagree slightly. right now this system is the best in the world for taking care of all comers however sick. it is, however, crumbling, and crumbling because of mismanagement, overreaching federal law, and a refusal to take care of the folks that actually make it great... paramedics, nurses, techs, and docs (and everyone else who makes it spin). why would anyone go into medicine these days? why? we are all trying to escape. thanks for your kind comments and stop by anytime. 911doc

I'm pissed! The amex # posted is no good! I lost my bid on that flat panel I was working for. You be Ho's not Docs, Docs always have good amex #s. I'm callin the "HIPPO BITCH" folks you keep refering to. Bet she has some weight to throw around. Your days are numbered as a TRUE blogger.